Swollen Ankle

Get rid of a Swollen Ankle… FAST!

Ankle sprains are very common injuries in any sport that involves jumping, landing, twisting, turning and sprinting. More so in sports that involve contact either in the air or during handling of the ball or fending off an attacker.

These ankle sprains involve a force where a player is “thrown over” a turned in ankle and typically causes an inversion sprain of the Lateral (outside) ligaments and more commonly the Anterior TaloFibular Ligament (ATFL).

Classification of Ligament Sprains

• Grade 1 – Mild damage to ligament(s) without instability of the joint
• Grade 2 – Partial tear of ligament(s) with mild instability of the joint
• Grade 3 – Full tear of ligament(s) with instability of the joint

Immediate Treatment

Most treatment protocols will consist of the “normal” R.I.C.E protocol – Rest Ice Compression Elevation.

This protocol involves wrapping or strapping an Ice pack around the ankle with a compression bandage and keeping the leg elevated above the heart level to ensure “draining” of the swelling. Very few athletes will continue with this after the injury, let alone the 48 – 72 hours following that! Yet it is very important to continue with this to ensure speedy recovery and prevent excessive swelling in the joint.

A course of Anti-Inflammatories are usually prescribed to help with the recovery process.

Although this is the Golden standard of protocols, there is one problem (in my opinion) with this. The restriction of movement after the initial 24 hours causes the joint to stiffen up and lose vital proprioception needed for functioning and walking. So a stiff joint invariably leads to a compensatory walking pattern or even a limp! And as most therapists would agree, we aim to get the joints working as normally as possible and as soon as possible. So why do we restrict it so much if we want it working?

The solution?… The CryoKinetic Bath

This is a technique I came across whilst working with athletes who had very little recovery time before their next event/match and it also worked wonders for an athlete who sprained his ankle 3 weeks before a marathon! There was NO WAY I was going to tell this athlete he couldn’t run the marathon after all his months of preparation. In fact he was so determined to follow my instructions he even set his alarm for every 3 hours and got up in the middle of the night to do it!

So the protocol…

The first 24 Hours: R.I.C.E

Thereafter: Every 2-3 Hours the CryoKinetic Bath for 25 minutes

• Bucket filled with ice and water to mid Calf level
• The leg will be submerged for the entire duration
• Leg is submerged and kept still for 10 minutes
• 1 minute pain-free partial squats (sitting to standing)
• 1 minute rest
• 1 minute pain-free calf raises (up on to toes)
• 1 minute rest
• Repeat the cycle of 1 Minute activity / 1 Minute rest until the 25 minutes are up

As mentioned before it is absolutely vital that these activities are performed pain free as you don’t want to cause more damage to the structures. However, you will notice that as you perform this more frequently and as you progress during the session it will become easier to perform these exercises.

This is because the icy cold water actually blocks the pain signals being sent through the pain sensors (nociceptors) to the brain. Then with the movement being added through the joint we are stimulating the proprioceptors and mechanoreceptors in the joint to assist in providing much needed function and stability.

This also works a charm on ankles that are chronically swollen after injury or old recurring injuries. As a warning and disclaimer though.

Do not perform this if you have any issues that may affect your sensation like Diabetes or Nerve Palsies / Neuropathies!

In future posts I will discuss rehabilitation and balance exercises for the ankle and what you can do to improve ankle stability.